The British Asthma Guidelines

The British asthma guidelines on the Management of Asthma were published in the May 2008 issue of Thorax. These guidelines focus on diagnosis for both adults and children; a section on those situations and includes occupational asthma, asthma in pregnancy and the new topic of difficult asthma; updated sections on pharmacological and non-pharmacological management; and combined sections on patient education and compliance, and on organization of care and audit. Over here I am going to give an abstract of what the British Asthma Guidelines are all about.

Asthma in children:

Firstly it focuses upon the more important issues which are the presence of asthma or other allergies in family and the patient's history. The initial assessment also considers the use of alternative diagnoses. There are many features that increase the probability of asthma in a child ranging from various symptoms like wheeze, cough, difficulty breathing, chest tightness - particularly if these are frequent and recurrent; are worse at night and in the early morning; occur after exercises or certain other triggers, like pets; cold or damp air, or triggering with emotions. There are certain other symptoms in children, which show that the probability of asthma is lowered down for example; symptoms appear with colds only, with no interval symptoms; cough without wheeze or difficulty breathing; if there has been a family history of moist cough; prominent dizziness, light-headedness, peripheral tingling; frequently normal physical examination of chest when symptomatic; the biggest sign is that there is no response to a trial of asthma therapy; clinical features pointing to alternative diagnosis.

Usually a child can be put into one of the three following groups;

High probability group where it is likely that the child is suffering from asthma.

Low probability group where it is not very likely that the child is suffering from asthma at all.

And then there is intermediate probability where the diagnosis is hugely uncertain.

Now we also keep this in mind that when it comes to diagnosis in children it is based upon a characteristic pattern of episodic symptoms in the absence of an alternative explanation.

Asthma in adults:

As far as initial assessment in concerned the diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms and signs and the particular absence of another explanation for them. Over here as well, patient's history is of utmost importance.

Adult asthma also has specific clinical features that increase the probability of asthma which are mainly having more than one of the following symptoms: wheeze, breathlessness, chest tightness and cough, particularly if symptoms get worse at night and in the early morning, symptoms appear in response to exercise, allergen exposure and cold air, symptoms occur after taking aspirin or beta blockers, there is a history of atopic disorder, there has been a history of asthma and/or atopic disorder etc. features that decrease the probability of asthma could be prominent dizziness, light-headedness, peripheral tingling, chronic productive cough in the absence of wheeze or breathlessness, repeatedly normal physical examination of chest when symptomatic, voice disturbance, symptoms appear with colds only.

We can distribute the adults into three groups as well;

High probability group where asthma is almost certain and you can start with asthma treatment as soon as possible.

Low probability group where symptoms are thought to be due to something else but asthma and some alternative diagnosis can be decided upon usually.

• Then of course there is an intermediate probability group where the diagnosis is uncertain and more tests are to be carried out in order to be extremely sure of what's going on.